Claim Follow Up. Availity Customer Connection Availity, LLC All Rights Reserved

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1 Claim Follow Up Availity Customer Connection

2 What We Will Cover Streamline administrative workflow with a single connection to multiple health plans for claim status, remittance, and review Compliance Claim Status Inquiry Electronic Remittance Advice (ERA) Remit Reader Additional Claim Follow Up 2

3 5010 Compliance Send and Receive 5010-Compliant Transactions Visit Up-convert and down-convert support Testing with technology companies Health plan readiness 5010 Tips via 3

4 What We Will Cover Streamline administrative workflow with a single connection to multiple health plans for claim status, remittance, and review Compliance Claim Status Inquiry Electronic Remittance Advice (ERA) Remit Reader Additional Claim Follow Up 4

5 Claim Status Inquiry Availity s Claim Status Inquiry feature is a fast, easy way to check the claim status. Availity connects to multiple health plans, providing one, easy place to check claim status at no charge. Save money with this no cost service. Save time by quickly checking the status of claims for many health plans, including delay and denial reasons. Manage accounts receivables with real-time information. Reduce or eliminate calls to payers regarding claim status. Access remittance information online in real time. 5

6 Claim Status Inquiry, (cont.) 1. Click Claims Management Claim Status Inquiry. 2. Select the payer and let the page refresh. Availity displays the appropriate version 3. Complete the required fields and click Submit. 4. View and print the results. a. Click Print. b. Click Return to Search or Edit Inquiry. c. For more information, click the page links. 6

7 Claim Status Inquiry Example Partial 4010 example 7

8 Claim Status Summary Results Example Humana partial example 8

9 Claim Status Inquiry Example Partial BCBSGA example 9

10 Claim Status Summary Results Example BCBSGA partial example 10

11 Claim Status Detail Results Example BCBSGA example 11

12 Claim Status Detail Results Example BCBSGA partial example top section 12

13 Claim Status Detail Results Example BCBSGA partial example - Service Line Status section 13

14 BCBSGA Secure Message Link-Out From Claim Status Detail Result From the Availity menu, click Claims Management Secure Messaging Want to learn more about Secure Messaging? Click Help, and then Blue Cross Blue Shield of Georgia Tools in Contents. 14

15 Claim Status Results Example Humana partial example 15

16 Claim Status Detail Results Example Humana partial example 16

17 Claim Status Detail Results Humana Link- Outs If the Correct This Claim link or Send an Attachment link displays, you can click to access Humana's applications. Want to learn more about these features? Click Help, and then HumanaTools in Contents. 17

18 Claim Status Remittance Information Example Partial example 18

19 Claim Status Summary Results Example Partial example 19

20 Claim Status Detail Results Example Partial example 20

21 Claims Management Link-Outs In the Availity menu under Claims Management, Availity offers a number of additional tools to help you manage your accounts receivable. Some of these tools are payer-specific and require additional registration. To learn more about these payer links, click Help at the top of any page and click the payer s name under Contents. 21

22 Claims Management Tools To learn about additional claims management tools and resources, in Availity Help, click a payer tools topic. When you access these tools, a new browser window opens and automatically displays the web site for this tool. For instructions about how to use this tool, see the instructions on the web site. Humana's Claim Review tool enables you to review claims processed by Humana and either accept or appeal them. To explore information about this link-out, click Help, and then Humana Tools Reviewing Claims with Humana. 22

23 Claim Reconciliation Tools From the Claims Management menu, Availity offers a number of additional tools to help you manage your account receivables. Some of these tools are payer-specific and require additional registration. Claim Reconciliation tools typically enable you to manage account receivables by viewing the statuses of multiple claims in one view. This is a faster, easier way to reconcile your accounts and reduce outstanding bills at no charge. Review the results of several claims from multiple health plans at one time within parameters you determine, such as by date range or by status. 23

24 Claim Reconciliation Tool - Humana Availity provides a link to the Humana Claim Reconciliation tool. 1. In the Availity menu, click Claims Management Claim Reconciliation Tool. 2. On the page that displays, select the payer and organization, and then click Next. 3. After you accept the disclaimer, the payer's website for this tool displays. 24

25 What We Will Cover Streamline administrative workflow with a single connection to multiple health plans for claim status, remittance, and review Compliance Claim Status Inquiry Electronic Remittance Advice (ERA) Remit Reader Additional Claim Follow Up 25

26 Electronic Remittance Advice (ERA) The Electronic Remittance Advice (ERA) service allows you to manage accounts receivable in one place, helping you improve your revenue cycle management by providing you with electronic payment explanations from multiple health plans. Organizations must enroll with payers to receive ERAs from participating payers. ERAs can be accessed online and downloaded to your computer at no charge. Availity also integrates with several practice management and hospital information systems to help automate accounts receivable postings. 26

27 Frequently Asked Questions (FAQs) Q: If my organization submits claims through another clearinghouse, can we still receive ERAs through Availity? A: Yes, your organization can receive ERAs at no charge through Availity regardless of how you submitted the claim. Q: What if I don t see the menu options when I log in to Availity? A: Check with your organization s Availity administrator to provide you with the roles and permissions needed to use these tools and more. Click Who controls my access? at the top of any page. Q: How do I get more information after this conference? A: Availity provides a no cost, comprehensive Availity Help system, no cost Client Services support and no cost webinars each month. 27

28 Registering to Receive ERAs 1. View the Health Plan List to verify which plans support ERAs. Visit availity.com and click Download Library, then Health Plans. 2. Log in to the Availity portal. 3. Click Electronic Remittance Advice Delivery in the Training and Resources section of the Home page. You can also take steps to register directly in the Health Plan list. 4. Use the health plan s form or process to complete registration. 28

29 Understanding the Health Plan List In the ERA section, Availity lists ERA health plan partners alphabetically. Columns include Payers, Comments, Availity Required Forms (links), and Payer Specific forms (links). To locate payer IDs, view the EDI Clearinghouse Health Plans Partners portion of the document. 29

30 Retrieving ERAs in Availity 1. Click EDI File Management Send and Receive Files. 2. Click Receive Files. 3. Download files with the.era or.zip file extension. For more information about Availity s file naming convention for ERAs, search for ERA or 835 in Availity Help. 30

31 What We Will Cover Streamline administrative workflow with a single connection to multiple health plans for claim status, remittance, and review Compliance Claim Status Inquiry Electronic Remittance Advice (ERA) Remit Reader Additional Claim Follow Up 31

32 Remit Reader Overview Search, view, sort, print, and reconcile electronic remittance advice (ERA) or 835 files. Each organization must enroll with the payers to receive ERAs. Access the Availity Health Plan Partners list and scroll to Availity's Electronic Remittance Advice (ERA) Health Plan Partners section to find the enrollment form(s) required for each payer. In the Availity menu, click Claims Management Remit Reader. 32

33 Tips for Completing the Form Search for ERAs by check, patient, or claim. Under Optional Search Criteria, search all or some payers or one payer in the list. The payers in the list are based on the payers with whom your organization has enrolled to receive ERAs through Availity. Search through seven years of historical information beginning with ERAs received after November 20,

34 Remit Reader Search Types and Options Search by Check Search by Patient Includes optional date range search Search by Claim 34

35 Optional Search Criteria In the Optional Search Criteria section, you can search all payers or select one or more from the list. Payers not yet selected Selecting certain payers: 1. To search by one or more, but not all, payers, select No. The list of available payers display. 2. In the Available Payers list, select the payer(s.) Payers selected Hold your CTRL key to select non-adjacent payers Hold you Shift key to select adjacent payers. 3. Click the right arrow to move the selections to the Selected Payers list. 35

36 Viewing and Sorting Results When you click Search, search results display in a table. If your request returns more than 300 results, you must enter more criteria to limit your search. To view more information, click the hyperlinked item in the table. When searching by check, click the check/eft trace number. When searching by patient or claim, click the claim number or check/eft trace number. On some pages, to sort messages by one of the columns, click the column header. You can sort in ascending or descending order, as signified by the arrow next to the header. 36

37 Search by Check Results Example 37

38 Check Details Example Navigation Sections Check Summary Provider Adjustment Details with expandable/collapsib le code descriptions Claim Summary 38

39 Create PDF Option Check Details 39

40 Claim Details Remark Codes Expanded expanded 40

41 What We Will Cover Streamline administrative workflow with a single connection to multiple health plans for claim status, remittance, and review Compliance Claim Status Inquiry Electronic Remittance Advice (ERA) Remit Reader Additional Claim Follow Up 41

42 Additional Claims Follow-Up Information Claim follow-up Use Claim Status Inquiry later Use online remittance for participating payers (via Claim Status Inquiry) Use remittance link outs to payer applications Use claim reconciliation, research, and review tools for several payers Corrected claims through web data entry Available for several payers Refer to Frequency field related help topic Claim attachments tool Available for Humana via Claim Status Inquiry Claims correction tool Available for Humana via Claim Status Inquiry 42

43 Using Other Payer Remittance Tools Availity offers a link to Humana's Provider Remittance Advice Inquiry tool. This tool enables you to search for specific remittance information from Humana by automated clearinghouse (ACH) number or check number, claim number, service date, and voucher date. Accessing This Tool: In the Availity menu, click Claims Management Remittance Review. A new browser window opens and automatically displays the Humana web site for this tool. 43

44 Thank you Call AVAILITY ( ) Or visit us online at 44